Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents

Sickle Cell Disease Program Evaluations

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0915-0344 can be found here:

Documents and Forms

Document Name Document Type
Form 006_Sickle Cell_Pe Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents Form
ATTACH_P_scoring_PedsQL_v6.pdf Instruction
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_teens ATTACH_I_PedsQL-4.0-Core-A_child_teens.doc Form
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_8-12 ATTACH_J_PedsQL-4.0-Core-C_child_8-12.doc Form
006_Sickle Cell_Pe 006_Sickle Cell_PedsQL_Child_5-7 ATTACH_O_PedsQL-4.0-Core-YC_child_5-7.doc Form

Information Collection (IC) Details

IC Title:	Sickle Cell Disease Treatment Demonstration Program (SCDTDP) Evaluation - PedsQL for children & adolescents	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	006_Sickle Cell_PedsQL_Child_teens	006_Sickle Cell_PedsQL_Child_teens	ATTACH_I_PedsQL-4.0-Core-A_child_teens.doc	Yes	Yes	Fillable Fileable
Form	006_Sickle Cell_PedsQL_Child_8-12	006_Sickle Cell_PedsQL_Child_8-12	ATTACH_J_PedsQL-4.0-Core-C_child_8-12.doc	No	Yes	Fillable Fileable
Form	006_Sickle Cell_PedsQL_Child_5-7	006_Sickle Cell_PedsQL_Child_5-7	ATTACH_O_PedsQL-4.0-Core-YC_child_5-7.doc	Yes	Yes	Fillable Fileable
Instruction			ATTACH_P_scoring_PedsQL_v6.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.